Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns
Determinants of good adherence to hand hygiene among healthcare workers who have extensive exposure to hand hygiene campaigns
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DOI：
10.1086/521663
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发表时间：
2007-11-01
影响因子：
4.5
通讯作者：
Pittet, Didier
中科院分区：
文献类型：
--
作者：
Sax, Hugo;Uckay, Ilker;Pittet, Didier
OBJECTIVE.在一家有10年手部卫生规范历史的医疗机构中，量化医务人员遵守手部卫生动机的不同行为成分。横断面研究，通过使用匿名的，自我管理的问卷。一所拥有2,200张床位的大学教学医院。分层随机抽样的2,961医疗和护理人员。共回收问卷1，042份（35.2%）。在受访者中，271人（26.0%）是医生，629人（60.4%）是护士，141人（13.5%）是护理助理。总体而言，1 008名答卷人提供了有关性的信息;其中718人（71.2%）是妇女。受访者提供的人口统计信息和数据的各种行为，规范和控制的信念，决定了他们的意图方面执行手卫生。在行为信念中，331名（32.1%）受访者认为医疗保健相关感染对患者来说是严重的，这是行为的决定因素，891名（86.0%）受访者认为手部卫生可以有效预防这些感染。在规范性信念中，760名受访者（73.7%）认为来自患者的手部卫生的社会压力排名靠前，687名（66.8%）来自上级的压力排名靠前，596名（57.9%）来自同事的压力排名靠前，687名（68.8%）来自最有影响力的人的压力排名靠前。在控制信念中，670名受访者（65.1%）对手部卫生相对容易进行的看法评价很高。自我报告的高手部卫生依从率（定义为在80%或更多的手部卫生机会中正确的手部卫生表现）与女性性别、接受手部卫生培训、参与先前的手部卫生活动、同事的同伴压力、同事的良好依从性以及手部卫生相对容易执行的看法独立相关。在手部卫生运动有着悠久传统的环境中，行为信念强烈支持手部卫生，但坚持是由同伴压力和高自我效能感驱动的，而不是通过推理手部卫生对患者安全的影响。女性性别，培训和运动暴露增加遵守手部卫生的可能性。这种额外的洞察力可以帮助塑造未来的促销活动。
OBJECTIVE. To quantify the different behavioral components of healthcare workers' motivation to comply with hand hygiene in a healthcare institution with a 10-year history of hand hygiene campaigning.DESIGN. Cross-sectional study, by use of an anonymous, self-administered questionnaire.SETTING. A 2,200-bed university teaching hospital.PARTICIPANTS. A stratified random sample of 2,961 medical and nursing staff.RESULTS. A total of 1,042 questionnaires (35.2%) were returned. Of the respondents, 271 ( 26.0%) were physicians, 629 (60.4%) were nurses, and 141 (13.5%) were nursing assistants. Overall, 1,008 respondents provided information about sex; 718 (71.2%) of these were women. Respondents provided demographic information and data about various behavioral, normative, and control beliefs that determined their intentions with respect to performing hand hygiene. Among behavioral beliefs, the perception that healthcare-associated infections are severe for patients was highly ranked as a determinant of behavior by 331 (32.1%) of the respondents, and the perception that hand hygiene is effective at preventing these infections was ranked highly by 891 respondents (86.0%). Among normative beliefs, perceived social pressure from patients to perform hand hygiene was ranked highly by 760 respondents (73.7%), pressure from superiors was ranked highly by 687 (66.8%), pressure from colleagues was ranked highly by 596 (57.9%), and pressure from the person perceived to be most influential was ranked highly by 687 (68.8%). Among control beliefs, the perception that hand hygiene is relatively easy to perform was rated highly by 670 respondents (65.1%). High self-reported rates of adherence to hand hygiene ( defined as performance of proper hand hygiene during 80% or more of hand hygiene opportunities) was independently associated with female sex, receipt of training in hand hygiene, participation in a previous hand hygiene campaign, peer pressure from colleagues, perceived good adherence by colleagues, and the perception that hand hygiene is relatively easy to perform.CONCLUSIONS. In a setting with a long tradition of hand hygiene campaigns, behavioral beliefs are strongly in favor of hand hygiene, but adherence is driven by peer pressure and the perception of high self-efficacy, rather than by reasoning about the impact of hand hygiene on patient safety. Female sex, training, and campaign exposure increased the likelihood of compliance with hand hygiene. This additional insight can help to shape future promotional activity.